<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN"
    "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml"
      xmlns:h="http://java.sun.com/jsf/html"
      xmlns:f="http://java.sun.com/jsf/core"
      xmlns:ui="http://java.sun.com/jsf/facelets"
      xmlns:o="http://openfaces.org/"
      xmlns:c="http://java.sun.com/jstl/core">

    <head>
    </head>
    
    <body>
        <ui:composition template="/templates/default.xhtml">
		 	<ui:define name="title">OpenHDS - Create Post Neonatal VPM</ui:define>
		
			<ui:param name="crud" value="#{postneonatalVPMCrud}" />
        
            <ui:define name="listing">
                <ui:include src="list.xhtml" />
            </ui:define>
            <ui:define name="display">
            
            	<h:outputText value="#{navController.breadcrumbTrail}" />
            
                <h1>#{msg.postneonatalvpmCreate}</h1>
                <h:messages id="errors" globalOnly="true" />
                <h:form id="form">
                    <h:panelGrid columns="4">
                    
                    	<h:outputText value="#{msg.individualId}:"/>
	            		<h:outputText />
	            		<h:inputText styleClass="individual" autocomplete="off" id="indiv" value="#{postneonatalVPMCrud.item.individual}" converter="#{individualExtIdConverter}" />
	            		<h:message for="indiv" errorClass="error" errorStyle="color: red" infoStyle="color: green"/>
                    	
                    	<h:outputText value="#{msg.visitId}:" />
                		<h:outputText />
                		<h:inputText styleClass="visit" autocomplete="off" id="visit" value="#{postneonatalVPMCrud.item.visit}" converter="#{visitExtIdConverter}" />
                		<h:message for="visit" errorClass="error" errorStyle="color: red" infoStyle="color: green"/>	
                
                		<h:outputText value="#{msg.postneonatalvpmRecordedDate}: (#{siteProperties.dateFormat})" />
                		<h:outputText />
                		<o:dateChooser id="recordedDate" value="#{postneonatalVPMCrud.recordedDate}" pattern="#{siteProperties.dateFormat}" />
                		<h:message for="recordedDate" errorClass="error" errorStyle="color: red" infoStyle="color: green"/>
	            	
                		<h:outputText value="#{msg.fieldWorkerId}:"/>
                      	<h:outputText />
                      	<h:inputText styleClass="collectedBy" autocomplete="off" id="fwId" value="#{postneonatalVPMCrud.item.collectedBy}" converter="#{fieldWorkerExtIdConverter}" />
                      	<h:message for="fwId" errorClass="error" errorStyle="color: red" infoStyle="color: green"/>
                   
                    </h:panelGrid>
                    <script>
		            	document.getElementById('form:indiv').focus();
		            </script>
                    <br />
                    <h:commandButton action="#{postneonatalVPMCrud.create}" value="#{msg.lblCreate}"/>
                </h:form>
            </ui:define>
        </ui:composition>
    </body>
</html>